Hypertension

Hypertension

1. Hypertensive

   • 160/95mmHg

2. Borderline hypertensive

   • 140/90mmHg

3. Essential

   • No definitive cause Managed by drugs and modification fo lifestyle factors

4. Secondary

   • Due to a pathology. Causes: - renal disease - renal artery stenosis - endocrine disease - tumour of the adrenal medulla - hypersecretion of catecholamines -drugs/food - e.g corticosteroids, steroids, liquorice

5. Hypertensive vessel wall changes

   • Increased smooth muscle content leads to a thickened tunica media, causing narrowing of the lumen therefore increasing TPR and increasing risk of obstruction which would lead to tissue ischaemia.

6. Consequences of hypertension

   • Endothelial damage Atheroma formation Risk of vessel becoming weak and rupturing Risk of organ damage Premature death

7. Doubles the risk of heart attack

8. Management

   • ACE inhibitors - to decrease TPR and blood volumeBeta blockers - decrease work of the heartCa2+ antagonsists - VD and decrease work of the heartArterial dilators - decrease TPRDiuretics - decrease blood volume Modification of lifestyle Regular exercise
   • Exercise regs
     • Mod intensity 60-75% HR max. Aerobic exercise 5x per week for 30 mins at a time Strength training 2-3 times per week 1-3 sets of 12-15 reps.
     • Exercise benefits
       • Short term
         • Resets BP regulatory mechanisms - up to 12 hour decrease in BP in those with hypertension
       • Long term
         • Prevents/treats obesity Decreases insulin resistance Promotes adaptations to sk muscles to increase pumping efficiency
     • Exercise considerations
       • Do not exercise if systolic BP >200mmHg or diastolic >110mmHg Avoid overgripping Hypotensive episodes are common secondary to hypertensive meds so avoid posutral changes and keep the feet moving.